Association Between Dysphagia and Inpatient Outcomes Across Frailty Level Among Patients ≥ 50 Years of Age

Abstract

Frail patients may have heightened risk of dysphagia, a potentially modifiable health factor. Our aim is to examine whether the relationship between dysphagia and adverse health outcomes differs by frailty conditions among inpatients ≥ 50 years of age. Medical or surgical hospitalizations among patients ≥ 50 years of age in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2014 through the first three quarters of 2015 were included. Adverse outcomes included length of stay (LOS), hospital costs, in-hospital mortality, discharge status, and medical complications. Dysphagia was determined by ICD-9-CM codes. Frailty was defined as (a) ≥ 1 condition in the10-item Johns Hopkins Adjusted Clinical Groups (ACG) frailty measure and a frailty index for the (b) ACG and (c) a 19-item Frailty Risk Score (FRS) categorized as non-frail, pre-frail, and frail. Weighted generalized linear models for complex survey designs using generalized estimating equations were performed. Of 6,230,114 unweighted hospitalizations, 4.0% had a dysphagia diagnosis. Dysphagia presented in 3.1% and 11.0% of non-frail and frail hospitalizations using the binary ACG (p < 0.001) and in 2.9%, 7.9%, and 16.0% of non-frail, pre-frail, and frail hospitalizations using the indexed FRS (p < 0.001). Dysphagia was associated with greater LOS, higher total costs, increased non-routine discharges, and more medical complications among both frail and non-frail patients using the three frailty definitions. Dysphagia was associated with adverse outcomes in both frail and non-frail medical or surgical hospitalizations. Dysphagia management is an important consideration for providers seeking to reduce risk in vulnerable populations.

Keywords: Deglutition; Deglutition disorders; Dysphagia; Frailty; Inpatient; Outcomes; Swallowing.

Fig. 1

Distribution of outcomes by dysphagia and binary 10-item stay and total cost of discharge, the point represents the median and Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnosis indicators frailty measure. D dysphagia, F frailty. For length of the bars represent the Q1 and Q3, respectively

Fig. 2

Distribution of outcomes by dysphagia and 19-item Frailty Risk Score indexed and categorized by non-frail, pre-frail, frail. The non-frail, pre-frail, frail cut-points were ≤ 0.08, > 0.08 but < 0.25, and ≥ 0.25, respectively. D dysphagia, F frailty. Pre-F pre-frail. For length of stay and total cost of discharge, the point represents the median and the bars represent the Q1 and Q3, respectively